From the Guidelines
Cardiac catheterization is associated with significant risks, including a mortality rate of 0.14% overall, with higher rates in certain patient populations such as those with left main disease (0.86%) or congestive heart failure (up to 0.12%) 1. The risks associated with cardiac catheterization include:
- Bleeding, bruising, or infection at the insertion site
- Allergic reactions to the contrast dye used during the procedure
- Kidney damage from the contrast material
- Blood vessel damage or tears
- Abnormal heart rhythms
- Blood clots that can lead to stroke or heart attack
- Death, although rare, occurring in less than 1% of diagnostic procedures 2 These risks are increased in patients with certain conditions, such as:
- Kidney disease
- Diabetes
- Advanced age
- Severe heart disease, including coronary artery disease, congestive heart failure, and valvular heart disease 1
- Unstable angina
- Acute myocardial infarction
- Renal insufficiency
- Ventricular arrhythmias
- Cyanotic congenital heart disease
- Congenital heart disease, including arterial desaturation and pulmonary hypertension 1 It is essential for patients to be aware of these risks and for healthcare providers to carefully evaluate the potential benefits and risks of cardiac catheterization on a case-by-case basis, taking into account the individual patient's characteristics and medical history 2. During the procedure, patients may experience chest discomfort, bleeding at the insertion site, or nausea from the contrast dye. Most complications are temporary and treatable, but patients should promptly report any unusual symptoms like chest pain, shortness of breath, dizziness, or fever after the procedure. Despite these risks, cardiac catheterization remains a valuable diagnostic and treatment tool when performed by experienced healthcare providers in appropriate facilities, with benefits often outweighing the potential complications for patients with suspected heart conditions 2.
From the Research
Risks Associated with Cardiac Catheterization
The risks associated with cardiac catheterization (cardiac cath) include:
- Vascular complications such as hematoma, pseudoaneurysm, arteriovenous fistula, peripheral artery occlusion, and dissection, and retroperitoneal bleeding 3
- Bleeding complications, including femoral hematomas, femoral artery dissection, and pseudoaneurysms 4
- Access-site hematoma, which can be associated with patient factors such as body mass index, right atrial pressure, and dialysis dependence 5
- Secondary local and systemic complications after surgical repair, which can be more frequent compared to nonoperative management 6
Patient Factors and Complications
Patient factors can play a significant role in the development of complications after cardiac catheterization, including:
- Age: patients older than 60 years of age are at higher risk of vascular complications 6
- Sex: female patients are at higher risk of vascular complications 6
- Body mass index: higher body mass index is associated with an increased risk of access-site hematoma 5
- Co-morbid conditions: such as dialysis dependence, which can increase the risk of bleeding complications 5
Procedure-Related Complications
Procedure-related factors can also contribute to complications after cardiac catheterization, including:
- Coronary angioplasty: which can increase the risk of vascular complications compared to angiography alone 6
- Use of closure devices: which may not be associated with a decreased risk of vascular access complications 7
- Anticoagulation regimen: vigorous anticoagulation can increase the risk of complications, but the use of novel anticoagulants or warfarin may not be associated with an increased risk of access-site hematoma 7, 5